BMJ Media Bias

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Caregivers with limited language proficiency and their satisfaction with paediatric emergency care related to the use of professional interpreters: a mixed methods study

Objectives Communication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy. Design A mixed-methods study. Setting Paediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland. Participants and methods Caregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted. Results The study included 181 caregivers, 14 of whom received professional language interpretation.

BMJ     Jan 15, 2024

Cohort profile: the National Congenital Anomaly Registration Dataset in England

Purpose The National Congenital Anomaly and Rare Disease Registration Service (NCARDRS), part of National Disease Registration Service in National Health Service England, quality assures, curates and analyses individual data on the pregnancies, fetuses, babies, children and adults with congenital anomalies and rare diseases across England. The congenital anomaly (CA) register provides a resource for patients and their families, clinicians, researchers and public health professionals in furthering the understanding of CAs. Participants NCARDRS registers CAs occurring in babies born alive and stillborn, fetal losses and terminations in England. NCARDRS collects data from secondary and tertiary healthcare providers, private providers and laboratories covering fetal medicine, maternity or paediatric services.

BMJ     Jan 15, 2024

Randomised, siteless study to compare systematic atrial fibrillation screening using enrichment by a risk prediction model with standard care in a Swedish population aged >= 65 years: CONSIDERING-AF study design

Introduction Atrial fibrillation (AF) is the most common arrhythmia and confers an increased risk of mortality, stroke, heart failure and cognitive decline. There is growing interest in AF screening; however, the most suitable population and device for AF detection remains to be elucidated. Here, we present the design of the CONSIDERING-AF (deteCtiON and Stroke preventIon by moDEl scRreenING for Atrial Fibrillation) study. Methods and analysis CONSIDERING-AF is a randomised, controlled, siteless, non-blinded diagnostic superiority trial with four parallel groups and a primary endpoint of identifying AF during a 6-month study period set in Region Halland, Sweden. In each group, 740 individuals aged≥65 years will be included.

BMJ     Jan 15, 2024

Causes of maternal deaths in Sierra Leone from 2016 to 2019: analysis of districts maternal death surveillance and response data

Introduction Sierra Leone is among the top countries with the highest maternal mortality rates. Although progress has been made in reducing maternal mortality, challenges remain, including limited access to skilled care and regional disparities in accessing quality care. This paper presents the first comprehensive analysis of the burden of different causes of maternal deaths reported in the Maternal Death Surveillance and Response (MDSR) system at the district level from 2016 to 2019. Methods The MDSR data are accessed from the Ministry of Health and Sanitation, and the secondary data analysis was done to determine the causes of maternal death in Sierra Leone.

BMJ     Jan 15, 2024

Reducing patient and planetary harms from high anticholinergic burden medication

What you need to knowPrescribing medicines with high anticholinergic burden carries significant risk of adverse clinical outcomes for patientsAnticholinergic burden scores can be a useful way of assessing anticholinergic burdenConsider tapering when stopping anticholinergic medications to avoid withdrawal effects, which may include nausea and sweatingOverprescribing and polypharmacy have been identified as a risk to patients and the planet.1 Prescribing medications with a high anticholinergic burden carries significant risk for patients, particularly older people. The adverse outcomes that result from this also incur substantial carbon and planetary burdens which might be mitigated by deprescribing anticholinergic drugs where appropriate.Why change is neededPolypharmacy (the concurrent use of multiple medication items by one individual)2 in older people are becoming increasingly common.34 ...

BMJ     Jan 15, 2024

Evaluation of clinical prediction models (part 2): how to undertake an external validation study

A clinical prediction model is used to calculate predictions for an individual conditional on their characteristics. Such predictions might be of a continuous value (eg, blood pressure, fat mass) or the probability of a particular event occurring (eg, disease recurrence), and are often in the context of a particular time point (eg, probability of disease recurrence within the next 12 months). Clinical prediction models are traditionally based on a regression equation but are increasingly derived using artificial intelligence or machine learning methods (eg, random forests, neural networks). Regardless of the modelling approach, part 1 in this series emphasises the importance of model evaluation, and the role of external validation studies to quantify a model’s predictive performance in ...

BMJ     Jan 15, 2024

The next government must put health at the heart of all policies

Dear party leaders,Not only is health the foremost concern of individuals, communities, and businesses, health is also an indicator of how well a nation is performing. Unfortunately, the situation in the UK is deeply concerning. As you no doubt are aware health is declining and health inequalities are widening. This is not the case in other European countries, and the UK is now well below the EU average for how long people can expect to live in good health. The UK’s rankings have gone down since 2014.While healthcare is important in treating ill health, the causes of ill health lie in the conditions in which people are born, grow, live, work, and age—tragically these conditions have deteriorated ...

BMJ     Jan 15, 2024

Fibroids and unexplained infertility treatment with epigallocatechin gallate: a natural compound in green tea (FRIEND) - protocol for a randomised placebo-controlled US multicentre clinical trial of EGCG to improve fertility in women with uterine fibroids

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Introduction Uterine fibroids affect 30%–77% of reproductive-age women and are a significant cause of infertility. Surgical myomectomies can restore fertility, but they often have limited and temporary benefits, with postoperative complications such as adhesions negatively impacting fertility. Existing medical therapies, such as oral contraceptives, gonadotropin hormone-releasing hormone (GnRH) analogues and GnRH antagonists, can manage fibroid symptoms but are not fertility friendly. This study addresses the pressing need for non-hormonal, non-surgical treatment options for women with fibroids desiring pregnancy. Previous preclinical and clinical studies have shown that epigallocatechin gallate (EGCG) effectively reduces uterine fibroid size. We hypothesise that EGCG from green tea extract will shrink fibroids, enhance endometrial quality and increase pregnancy likelihood.

BMJ     Jan 15, 2024

Cohort profile: The Scottish SHARE Mental Health (SHARE-MH) cohort - linkable survey, genetic and routinely collected data for mental health research

Purpose The SHARE Mental Health (SHARE-MH) cohort was established to address the paucity of clinical and genetic data available for mental health research. The cohort brings together detailed mental health questionnaire responses, routinely collected electronic health data and genetic data to provide researchers with an unprecedented linkable dataset. This combination of data sources allows researchers to track mental health longitudinally, across multiple settings. It will be of interest to researchers investigating the genetic and environmental determinants of mental health, the experiences of those interacting with healthcare services, and the overlap between self-reported and clinically derived mental health outcomes. Participants The cohort consists of individuals sampled from the Scottish Health Research Register (SHARE).

BMJ     Jan 15, 2024

Priority populations experiences of isolation, quarantine and distancing for COVID-19: protocol for a longitudinal cohort study (Optimise Study)

Introduction Longitudinal studies can provide timely and accurate information to evaluate and inform COVID-19 control and mitigation strategies and future pandemic preparedness. The Optimise Study is a multidisciplinary research platform established in the Australian state of Victoria in September 2020 to collect epidemiological, social, psychological and behavioural data from priority populations. It aims to understand changing public attitudes, behaviours and experiences of COVID-19 and inform epidemic modelling and support responsive government policy. Methods and analysis This protocol paper describes the data collection procedures for the Optimise Study, an ongoing longitudinal cohort of ~1000 Victorian adults and their social networks. Participants are recruited using snowball sampling with a set of seeds and two waves of snowball recruitment.

BMJ     Jan 15, 2024

Understanding symptoms suggestive of long COVID syndrome and healthcare use among community-based populations in Manitoba, Canada: an observational cross-sectional survey

Objective This study aims to characterise respondents who have COVID-19 and long COVID syndrome (LCS), and describe their symptoms and healthcare utilisation. Design Observational cross-sectional survey. Setting The one-time online survey was available from June 2022 to November 2022 to capture the experience of residents in Manitoba, Canada. Participant Individuals shared their experience with COVID-19 including their COVID-19 symptoms, symptoms suggestive of LCS and healthcare utilisation. We used descriptive statistics to characterise patients with COVID-19, describe symptoms suggestive of LCS and explore respondent health system use based on presenting symptoms. Results There were 654 Manitobans who responded to our survey, 616 (94.2%) of whom had or provided care to someone who had COVID-19, ...

BMJ     Jan 15, 2024

Factors influencing implementation and sustainability of interventions to improve oral health and related health behaviours in adults experiencing severe and multiple disadvantage: a mixed-methods systematic review

Objectives Among people experiencing severe and multiple disadvantage (SMD), poor oral health is common and linked to smoking, substance use and high sugar intake. Studies have explored interventions addressing oral health and related behaviours; however, factors related to the implementation of these interventions remain unclear. This mixed-methods systematic review aimed to synthesise evidence on the implementation and sustainability of interventions to improve oral health and related health behaviours among adults experiencing SMD. Methods Bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, EBSCO, Scopus) and grey literature were searched from inception to February 2023. Studies meeting the inclusion criteria were screened and extracted independently by two researchers.

BMJ     Jan 15, 2024

IMPAACT: IMproving the PArticipAtion of older people in policy decision-making on common health CondiTions - a study protocol

Introduction Rapid population ageing is a demographic trend being experienced and documented worldwide. While increased health screening and assessment may help mitigate the burden of illness in older people, issues such as misdiagnosis may affect access to interventions. This study aims to elicit the values and preferences of evidence-informed older people living in the community on early screening for common health conditions (cardiovascular disease, diabetes, dementia and frailty). The study will proceed in three Phases: (1) generating recommendations of older people through a series of Citizens’ Juries; (2) obtaining feedback from a diverse range of stakeholder groups on the jury findings; and (3) co-designing a set of Knowledge Translation resources to facilitate implementation into research, policy and ...

BMJ     Jan 15, 2024

Cross-sectional survey of sexual health professionals experiences and perceptions of the 2022 mpox outbreak in the UK

Objective To understand the experiences and perceptions of sexual health professionals responding to the May 2022 mpox outbreak in the UK. Design Cross-sectional, anonymous, online survey collecting quantitative and qualitative data. Convenience sample recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness, support, and training; safety at work; vaccination; and well-being. Qualitative descriptive analysis of open-text responses was conducted to support interpretation of the quantitative data. Participants Participants who were employed as sexual health professionals in the UK and had direct clinical experience of mpox were included in the analysis.

BMJ     Jan 15, 2024

We know what we need to do to improve health and reduce inequalities, now we need politicians to act

“Hope is an orientation of the spirit … an ability to work for something because it is good…. It is not the same as optimism. It is not the conviction that something will turn out well, but certainty that something makes sense regardless of how it turns out.”1So said Václav Havel, playwright, dissident, and President of post-communist Czechoslovakia. He had been through it all before he played a key part in his country toppling communism and emerging blinking into the light. The UK in 2024, and at the beginning of an election year, is experiencing dark days of a different sort: population health has stopped improving and health inequalities are increasing.

BMJ     Jan 15, 2024

Economic burden of adverse perinatal outcomes from births to age 5 years in high-income settings: a protocol for a systematic review

Background Adverse perinatal outcomes such as preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death have devastating impacts on individuals, families and societies, with significant lifelong health implications. Despite extensive knowledge of the significant and lifelong health implications of adverse perinatal outcomes, information on the economic burden is limited. Estimating this burden will be crucial for designing cost-effective interventions to reduce perinatal morbidity and mortality. Thus, we will quantify the economic burden of adverse perinatal outcomes from births to age 5 years in high-income countries. Methods and analysis A systematic review of all primary studies published in English in peer-reviewed journals on the economic burden for at least one of the ...

BMJ     Jan 15, 2024